Objective:Based on the anatomical characteristics and clinical manifestations of congenital ossicular chain anomalies, this study aims to establish a selection strategy for ossiculoplasty and to evaluate surgical outcomes and prognosis, as well as to provide evidence for clinical management. Methods:A retrospective analysis was performed on the clinical data from patients with congenital ossicular chain malformation who underwent surgery at the Provincial Hospital Affiliated to Shandong First Medical University between 2019 and 2025. Patients were classified according to the Teunissen classification system. Surgical approaches, including endoscopic, microscopic, and combined endoscopic-microscopic techniques were selected based on each type, and their respective efficacy and prognosis were analyzed using a postoperative air conduction threshold of ≤25 dB HL as the criterion for therapeutic effectiveness. SPSS 26.0 was used for statistical analysis. Results:A total of 45 patients（46 ears） were included. According to Teunissen classification, patients with under Type Ⅰ（1 ear）, TypeⅡ（12 ears）, Type Ⅲ（31 ears）, and Type Ⅳ（2 ears） underwent endoscopic, microscopic, or combined surgery, respectively. The overall postoperative hearing was improved. Specifically, the air-bone gap（ABG） demonstrated a significant reduction postoperatively across all types, in Type Ⅰpatients, ABG decreased from 38 dB to 20 dB; in Type Ⅱ, from（42.67±13.56） dB to（23.41±11.95） dB; in Type Ⅲ, from（44.61±10.57） dB to（20.48±8.88） dB; and in Type Ⅳ, from（57.00±7.07） dB to（21.10±15.56） dB. The overall mean speech-frequency ABG significantly improved from（44.50±11.37） dB to（21.26±9.72） dB（t=11.343, P<0.001）. Only one patient developed mild postoperative facial nerve paralysis（House-Brackmann grade Ⅲ）. A closed-loop "diagnosis-classification-treatment" pathway was preliminarily established. Conclusion:Integrating anatomical classification with clinical presentation facilitates rational surgical planning. Flexible use of endoscopic, microscopic, or combined techniques improves surgical success and hearing outcomes and offers a systematic clinical pathway for individualized treatment of congenital ossicular chain malformation. 目的：基于先天性听骨链畸形的解剖特征与临床表现，建立听骨链手术重建方式的选择策略，评估其手术疗效及预后。 方法：回顾性分析2019年1月至2025年1月于山东第一医科大学附属省立医院接受手术的先天性听骨链畸形患者的临床资料，根据Teunissen分型进行分类，针对各分型分别采用耳内镜、显微镜、双镜联合入路的手术方式，以术后气导听阈≤25 dB HL为有效标准分析其疗效与预后。采用SPSS 26.0软件对术前术后听力结果进行统计学分析。 结果：共纳入45例患者（46耳）。按Teunissen分型，Ⅰ型（1耳）、Ⅱ型（12耳）、Ⅲ型（31耳）及Ⅳ型（2耳）患者分别接受耳内镜、显微镜或双镜联合手术。术后听力改善总体有效，各型术前-术后气骨导差值分别为：Ⅰ型患者ABG由术前38 dB显著降到20 dB；Ⅱ型由（42.67±13.56） dB显著降至（23.41±11.95） dB；Ⅲ型患者ABG由（44.61±10.57） dB显著降至（20.48±8.88） dB；Ⅳ型患者ABG由（57.00±7.07） dB显著降至（21.10±15.56） dB；患者术后言语频率平均气骨导差总体由术前（44.50±11.37） dB显著降至（21.26±9.72） dB（t=11.343，P<0.001）。1例患者术后发生面瘫（House-Brackmann Ⅲ级）。本研究初步建立了基于分型与术式选择的“诊断-分类-治疗”闭环诊疗路径。 结论：结合解剖分型与临床表现，可在术前制定合理的手术方案，术中灵活选择耳内镜、显微镜或双镜联合入路有助于提高手术成功率，改善患者听力预后，为先天性听骨链畸形的个体化治疗提供了系统性的临床路径。.
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